Procedural Volume and Outcomes with Atrial Fibrillation Ablation: A Report from the NCDR AFib Ablation Registry

Abstract

Background: Hospital and physician procedure volumes have been associated with outcomes for several cardiac procedures however this has not been well defined for atrial fibrillation (AF) ablation in the contemporary practice. Objective: To determine the association between hospital and physician procedural volume and success for AF ablation and the risk of major adverse events (MAE). Methods: Procedures reported to the NCDR AFib Ablation Registry between July 2019 and June 2022 were included. Physician and hospital procedural volumes were annualized and stratified into quartiles (Q) to compare success and MAE. Three level hierarchical (patient, hospital and physician) generalized linear models were used to assess the adjusted relationship between procedural volume and the likelihood of procedural outcomes. Results: A total of 70,296 first time AF ablation at 186 hospitals across the United States were included. The mean age was 66.1 ± 10.3 years, 36% were women, the mean CHA2DS2-VASc score was 2.7 ± 1.6, and 57.4% of patients had paroxysmal AF. The median annual procedural volume for hospitals and physicians were 230 (IQR:144.7-307.2) and 66 (IQR: 44.7-97.5), respectively. Overall, acute procedural success was 98.5 % and the MAE rate was 1.0%. With Q4 (highest) hospital volume as a reference, the adjusted likelihood of procedural success was significantly lower for Q1 (OR: 0.44, CI: 0.29-0.68), Q2 (OR: 0.50, CI: 0.33-0.75) and Q3 (OR: 0.60, CI: 0.40-0.89). Similarly, for physician, procedural success was less among Q1 (OR: 0.38, CI: 0.28-0.51), Q2 (OR: 0.51, CI: 0.38-0.69) and Q3 (OR: 0.55, CI: 0.42-0.72). With MAE, compared with Q4, there was an inverse relationship between procedural volume for hospitals in Q1 (OR: 1.78, CI: 1.26-2.51) but not Q2 (OR: 1.06, CI: 0.77-1.46) or Q3 (OR: 1.19, CI: 0.89-1.58) and for physicians in Q1 (OR: 1.93, CI: 1.44-2.58) and Q2 (OR: 1.49, CI: 1.13-1.97) but not in Q3 (OR: 1.22, CI: 0.94-1.58). An adjusted MAE ? 1% was predicted by an annual volume of approximately 190 for hospitals and 60 for physicians. Conclusion: In this national cohort, hospital and physician AF ablation procedural volumes were directly related to acute procedural success and inversely related to rates of MAE.